Clinical Effectiveness of Cardiac Rehabilitation and Barriers to Completion in Patients of Low Socioeconomic Status in Rural Areas: A Mixed-methods Study

Overview

Journal Clin Rehabil

Publisher Sage Publications

Specialty Rehabilitation Medicine

Date 2024 Apr 17

PMID 38631370

Authors

Alline Beleigoli

Hila Ariela Dafny

Maria Alejandra Pinero de Plaza

Claire Hutchinson

Tania Marin

Joyce S Ramos

Orathai Suebkinorn

Lemlem G Gebremichael

Norma B Bulamu

Wendy Keech

Marie Ludlow

Jeroen Hendriks

Vincent Versace

Robyn A Clark

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion.

Design: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study.

Setting: Economically disadvantaged areas in rural Australia.

Participants: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status.

Main Measures: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28).

Results: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57-0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00-1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02-2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14-2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18-0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion.

Conclusions: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.

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